| Familia Dental | |
|
2608 State St. East Saint Louis IL 62205-2325 | |
| (618) 857-2300 | |
| (618) 857-2302 |
| Full Name | Familia Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2608 State St., East Saint Louis, Illinois |
| Authorized Official Name and Position | Brandon Alexander Taylor (CREDENTIALING & PAYER RELATIONS MAN) |
| Authorized Official Contact | 8474537396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Familia Dental 2050 East Algonquin Road Suite 610 Schaumburg IL 60173-4166 Ph: (847) 453-7396 | Familia Dental 2608 State St. East Saint Louis IL 62205-2325 Ph: (618) 857-2300 |
| NPI Number | 1962792747 |
|---|---|
| Provider Enumeration Date | 04/13/2011 |
| Last Update Date | 06/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962792747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019026920 (Illinois) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Familia Dental Esl 4llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2608 State St, East Saint Louis, IL 62205 Phone: 888-988-4066 Fax: 847-496-7202 | |
Familia Dental Esl 4 Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2608 State St, East Saint Louis, IL 62205 Phone: 888-988-4066 Fax: 847-496-7603 |